Predicting why women have elective repeat cesarean deliveries and predictors of successful vaginal birth after cesarean

Abstract

Objective: To compare the characteristics of women who select elective repeat cesarean rather than trial of labor after cesarean (TOLAC) for delivery, and to determine individual predictors for success and failure within a TOLAC group and observe differences in maternal and neonatal morbidity.

Methods: The present descriptive, retrospective, observational study was performed in a regional obstetric unit in the United Kingdom. Data were collected from the Northern Ireland Maternity System database on all women who gave birth between April 2010 and April 2012, and had a previous cesarean delivery, and statistical analysis was performed.

Results: In total, 893 patients were included in the study: 385 underwent TOLAC and 493 underwent elective repeat cesarean. On comparison, women in the elective repeat cesarean group had a shorter inter-delivery interval and fewer had had a previous vaginal delivery (P<0.005). Predictors for success in the TOLAC group included previous vaginal delivery and a longer inter-delivery interval (P<0.05). Successful vaginal birth after cesarean (VBAC) did not have higher rates of maternal morbidity.

Conclusion: The majority of patients (56%) chose elective repeat cesarean rather than TOLAC, which has long-term implications both clinically and financially. A validated prediction model might improve patient counseling and identify women with a high likelihood of successful VBAC.

Keywords: Elective repeat cesarean; Predictors; Trial of labor after cesarean; Vaginal birth after cesarean.